MRT in der Gastroenterologie
ABSTRACT Die Magnetresonanztomographie (MRT) ist eines der wichtigsten diagnostischen Verfahren seit der Entdeckung der Rntgenstrahlen vor mehr als 100 Jahren. Das gastroenterologische Interesse ist derzeit auf das biliopankreatische System und auf Erkrankungen des Verdauungstrakts fokussiert. Die Magnetresonanzcholangiopankreatikographie (MRCP) ist hier bei einer Vielzahl von Erkrankungen des hepatobiliren Systems und des Pankreas bereits ein alternatives Verfahren zur diagnostischen endoskopisch-retrograden Cholangiopankreatikographie (ERCP). Die Darstellung des Dnndarms mittels MRT ist im Begriff, den konventionellen Rntgen-Sellink als Methode der Wahl abzulsen. Im Gegensatz hierzu steht die MR-Kolonographie noch am Anfang der Entwicklung und kann zum gegenwrtigen Zeitpunkt noch nicht als Screeningmethode empfohlen werden. Bei endoskopisch nicht passierbaren Kolonstenosen ist sie jedoch bereits heute ein zuverlssiges Diagnostikum zur Evaluation prstenotischer Kolonabschnitte. Fr den weiteren Fortschritt der MRT-Diagnostik im Bereich der Gastroenterologie ist eine enge Kooperation zwischen Gastroenterologen und Radiologen notwendig.Magnetic resonance imaging (MRI) has been called the most important development in medical diagnosis since the discovery of the X-ray more than 100 years ago. The effectiveness of MRI has been expanded to a variety of gastrointestinal disorders. The gastroenterologists attention is currently focused on biliopancreatic and bowel diseases. Magnetic resonance cholangiopancreatography (MRCP) has become a competitive replacement for diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in a variety of hepatobiliary and pancreatic diseases. MR enteroscopy has the potential to become the preferred method for evaluating the entire small bowel, while on the other hand virtual colonoscopy is far from being promoted as a tool for general screening purposes in suspected colon diseases. In summary, whether or not the survival of endoscopy is under debate, MRI could mark a historic turning point in gastroenterology. So, MRI hardware might interdisciplinarily be used by, e. g., radiologists and gastroenterologists.
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ABSTRACT: Magnetic resonance imaging (MRI) has been described as the most important development in medical diagnosis since the discovery of the roentgen ray more than 100 years ago. The effectiveness of MRI has been extended to make it applicable in a wide variety of gastrointestinal disorders. The attention of gastroenterologists is currently focusing on pancreaticobiliary and bowel diseases. Magnetic resonance cholangiopancreatography (MRCP) has become a competitive alternative to diagnostic endoscopic retrograde cholangiopancreatography in a variety of hepatobiliary and pancreatic diseases. Magnetic resonance enteroscopy has the potential to become the preferable method for evaluating the entire small bowel; virtual colonoscopy, on the other hand, is far from the stage at which it could be promoted as a tool for general screening purposes in suspected colonic diseases. Its drawbacks include problems with standardization, implementation of the techniques in generalized settings, and patient acceptance.Endoscopy 06/2000; 32(5):406-10. · 5.74 Impact Factor
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ABSTRACT: To elucidate the risk of malignancy and the morphological alterations associated with malignancy. Thirty cases of intraductal papillary-mucinous tumors and 5 papillary-mucinous carcinomas (invasive intraductal papillary-mucinous tumors) of the pancreas were clinicopathologically and histopathologically analyzed. The invasive carcinoma developed on the basis of severe dysplasia-carcinoma in situ changes and never from mild or moderate dysplasia changes. However, tumor cell projections of intraductal papillary-mucinous tumors encroached into the duct wall and/or the stroma introduced just beneath the epithelium and "intraductal" tumor cells sometimes came in direct contact with the "extraductal" connective tissues even in adenomas. The frankly invasive adenocarcinoma components of invasive intraductal papillary-mucinous tumors were characterized by the lack or poor formation of their own basement membrane and were usually surrounded by the extensive collagenous proliferation, desmoplastic reaction. Such stromal alterations never developed around the "extraductal" components of non-invasive intraductal papillary-mucinous tumors. The risk of malignancy for an individual intraductal papillary-mucinous tumor was increased with the degree of cellular and/or structural atypia. The desmoplastic reaction with poor formation of the basement membrane is the sine qua non of the "true invasion".Hepato-gastroenterology 01/1999; 51(59):1489-94. · 0.77 Impact Factor
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ABSTRACT: Evaluation of MR-cholangiopancreaticography (MRCP) for the diagnosis of primary sclerosing cholangitis (PSC) in correlation with endoscopic retrograde cholangiopancreaticography (ERCP) and in comparison to the diagnostic accuracy of various T2-weighted sequences. Fifty-five patients (34 males, 21 females; mean age 40 years, range 16 to 65 years) with suspected PSC were examined in a 1.5 T MR unit (Magnetom Vision, Siemens, Erlangen), using breath-hold transverse and coronal HASTE, paracoronal RARE and thin-sliced HASTE (TS-HASTE) sequences. Applying a five-point-scale, two blinded investigators assessed the image quality for ROC analysis. Morphologic criteria of PSC were documented and correlated with ERCP, which served as the gold standard, and sensitivity, specificity and diagnostic accuracy were calculated. PSC was confirmed in 40 of 55 patients (ERCP 55 of 55, liver biopsy 37 of 55), with concomitant chronic ulcerative colitis in 27 and Crohn's disease in 6 of the 40 patients. Qualitative analysis of the image quality showed no significant difference between RARE, HASTE and thin-sliced HASTE sequences (3.4/3.5/3.2). The RARE sequence had the highest sensitivity (97 %), specificity (64 %) and accuracy (84 %) for the detection of PSC. The difference between HASTE and thin-sliced HASTE was statistically significant (p < 0.01). Of the 40 patients with confirmed PSC, 29 were followed by MRI and 3 underwent a liver transplantation within the follow-up period. A Klatskin tumor, which was misdiagnosed by MRCP, was diagnosed by brush biopsy in 1 of the 40 patients. Interobserver variability was adequate to good (kappa 0.4 to 0.7), depending on the chosen sequence. MRCP seems to be a reliable non-invasive imaging method to diagnose and follow PSC. The RARE sequence showed the highest diagnostic accuracy of the T2-weighted sequences.RöFo - Fortschritte auf dem Gebiet der R 02/2003; 175(2):203-10. · 2.76 Impact Factor